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					<h1 id="logo">VmakeUfitt</h1>
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			<h2>Your <span>personal information</span></h2>
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						<label>First name:</label>
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						<label>Middle name:</label>
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			<h2><span>Exercise Readiness Questionnaire</span> (ERQ)</h2>
			<ul id="erq_list">
				<li><span>NO</span> Has a physician ever diagnosed you with a heart condition and indicated you should restrict your physical activity?</li>
				<li><span>NO</span> When you perform physical activity, do you feel pain in your chest?</li>
				<li><span>NO</span> When you were not engaging in physical activity, have you experienced chest pain in the past month?</li>
				<li><span>NO</span> Do you ever faint or get dizzy and lose your balance?</li>
				<li><span>NO</span> Do you have an injury or orthopedic condition (such as a back, hip, or knee problem) that may worsen due to a change in your physical activity?</li>
				<li><span>NO</span> Do you have high blood pressure or a heart condition in which a physician is currently prescribing a medication?</li>
				<li><span>NO</span> Are you pregnant?</li>
				<li><span>NO</span> Do you have insulin dependent diabetes?</li>
				<li><span>NO</span> Are you 69 years of age or older and not used to being very active?</li>
				<li><span>NO</span> Do you know of any other reason you should not exercise or increase your physical activity?</li>
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			<a href="#" style="margin-left:40px;">Refill Exercise Readiness Questionnaire</a>
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